HAB Performance Measures Group 1 -
PCP Prophylaxis
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Performance Measure: PCP Prophylaxis -
OPR-Related Measure: Yes TOP |
Percentage of clients with HIV infection and a CD4 T-cell count below 200 cells/mm3 who were prescribed PCP prophylaxis.
Number of HIV-infected clients with CD4 T-cell counts below 200 cells/mm3 who were prescribed PCP prophylaxis
Number of HIV-infected clients who:
- had a medical visit with a provider with prescribing privileges [ 1 ], i.e. MD, PA, NP at least once in the measurement year, and
- had a CD4 T-cell count below 200 cells/mm3
- Patients with CD4 T-cell counts below 200 cells/mm3 repeated within 3 months rose above 200 cells/mm3
- Patients newly enrolled in care during last three months of the measurement year
- Is the client HIV-infected? (Y/N)
- If yes, was the CD4 T-cell count <200 cells/mm3 ? (Y/N)
- If yes, was PCP prophylaxis prescribed? (Y/N)
- If no, was the CD4 count repeated within 3 months? (Y/N)
- If yes, did it remain below 200 cells/mm3 ? (Y/N)
- If yes, was PCP prophylaxis prescribed? (Y/N)?
- Electronic Medical Record/Electronic Health Record
- CAREWare, Lab Tracker, or other electronic data base
- HIVQUAL reports on this measure for grantee under review
- Medical record data abstraction by grantee of a sample of records
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National Goals, Targets, or Benchmarks for Comparison TOP |
IHI Goal: 95% [ 2 ]
National HIVQUAL Data [ 3 ]
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2003 |
2004 |
2005 |
2006 |
Top 10% |
100.0% |
100.0% |
100.0% |
100.0% |
Top 25% |
100.0% |
100.0% |
100.0% |
100.0% |
Median* |
93.3% |
90.9% |
92.3% |
94.4% |
*from HAB data base
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Outcome Measures for Consideration TOP |
- Rate of PCP in the measurement year
- Mortality rates
- Cost savings
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Basis for Selection and Placement in Group 1 TOP |
Pneumocystis pneumonia (PCP) is the most common opportunistic infection in people with HIV. Without treatment, over 85% of people with HIV would eventually develop PCP. It is a major cause of mortality among persons with HIV infection, yet is almost entirely preventable and treatable. Pneumocystis almost always affects the lungs, causing a form of pneumonia. People with CD4 T-cell counts under 200 cells/mm3 are at greatest risk of developing PCP. The drugs now used to prevent and treat PCP include TMP/SMX, dapsone, pentamidine, and atovaquone. [ 4 ]
Before the widespread use of primary PCP prophylaxis and effective ART, PCP occurred in 70%-80% of patients with AIDS. The course of treated PCP was associated with a mortality rate of between 20% and 40% in persons with profound immunosuppression. Approximately 90% of cases occurred among patients with CD4 T-cell counts <200 cells/mm3. [ 5 ]
Measure reflects important aspect of care that significantly impacts survival and mortality. Data collection is currently feasible and measure has a strong evidence base supporting the use.
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US Public Health Service Guidelines TOP |
HIV-infected adults and adolescents, including pregnant women and those on HAART, should receive chemoprophylaxis against PCP if they have a CD4 T-cell count <200 cells/mm3. [ 6 ]
[1] A "provider with prescribing privileges" is a health care professional who is certified in their jurisdiction to prescribe ARV therapy.
[2] IHI Measure reads, "Percent of Patients with a CD4 Cell Count Below 200 cells/mm 3 Receiving Pneumocystis Carinii Pneumonia (PCP) Prophylaxis"
[3] http://www.hivguidelines.org/admin/files/qoc/hivqual/proj%20info/ HQNatlAggScrs3Yrs.pdf
[4] http://www.aidsinfonet.org/factsheet_detail.php?fsnumber=515
[5] Centers for Disease Control and Prevention. Treating opportunistic infections among HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association/Infectious Diseases Society of America. MMWR 2004;53(No. RR-15) ( http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5315a1.htm )
[6] Centers for Disease Control and Prevention. Guidelines for Preventing Opportunistic Infections Among HIV-Infected Persons - 2002 Recommendations of the U.S. Public Health Service and the Infectious Diseases Society of America . MMWR 2002;51 (No. RR-8) ( http://www.cdc.gov/mmwr/PDF/rr/rr5108.pdf or
http://aidsinfo.nih.gov/ContentFiles/OIpreventionGL.pdf )
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